The IoT in Healthcare – improving patient care in hospitals
How can the IoT improve patient care and safety?
I must go on record to state that I am not a healthcare expert. My aim here is just to seed some ideas that could go some way to improving our lives in the near and long term future.
Back in 2014 I sat through an IoT presentation citing the benefits of tracking a bottle of ketchup from production through the final bottle bottom bash to get the last drop onto our egg and bacon sandwich. I could see it would be beneficial to some marketing team somewhere but it didn’t strike me as world changing. But what if we coded the medicine containers with an IoT tag and the patient with a biometric verified IoT tag? Now when the medicine bottle was offered to the patients tag the nurse could be presented with the exact dose from that specific bottle for that specific patient. I suspect that would have a major positive impact on the risk of giving someone an incorrect does of medicine. Even in my limited exposure I know of three potentially life threatening situations so surely this is really what the IoT should be doing for us.
When my daughter was admitted to hospital the staff found it very extremely difficult to determine her baseline because she has Autism. As a result, some assumptions were made which delayed the procedures required to diagnose of her brain injury. People are always vulnerable when they are admitted to hospital but people with special needs are exposed to even greater risk for a multitude of reasons. Observation plays a big part in diagnosis in any field and observation relies on deviation from a baseline. If healthcare professionals do not know the baseline of a patient with special (and sometimes complex) needs, the potential for delayed or mistaken diagnosis increases along with the potential of serious consequences.
Even when a relative present it is still challenging to convey the baseline condition of a patient with special needs to the health professionals. Doctors in particular have very little exposure to patients as they tend to spend a matter of minutes each day with their patients. Even if you could convey the patient’s baseline that will only last until a shift change as there is only so much that can be captured in the admission notes. And on this point, it is very undignified for anyone to have a medical team parachute in to the foot of your bed and discuss your case notes at handover time. For people with special needs it can also be terrifying.
The biometrically verified IoT tag mentioned above could be linked to patient baseline information and updated by the healthcare professionals whenever they take their observations and carry out procedures. This could include a raft of information including food and fluid ingress and egress, medication side effects, mood changes, personal preferences, mobility, language capabilities and much more.
When my daughter was in the acute hospital the lack of coordination between the different healthcare disciplines astounded me. Staff losing time trying to track down vital life-saving equipment, only to discover on finding the equipment that it is faulty or out of calibration. I lost count of the number of times the physiotherapists arrived on the ward unannounced to find the patient was attending another appointment elsewhere in the building. Wasted trips to radiography, transport services unable to find patients, nursing staff unable to locate transport services, a lack of clarity as to who can authorize an MRI scan, even in my limited experience the list goes on. Unclear rules of engagement resulting in a complex mess that inevitably lands on the shoulders of front line nursing staff. I am sure my hospital experience is not unique so when you extrapolate this across the UK just how much is this costing?
The tragedy is, this is all so unnecessary. It is one of the easiest problems to resolve within a hospital using a wireless network with Real Time Location System. RTLS can be used to track equipment and people and can locate these resources on demand. It can also be integrated with an asset register to flag items that are due for maintenance or calibration. No longer will staff have to hunt down equipment only to find it is unserviceable.
Patients can also be equipped with RTLS tags to enable staff to locate them where ever they happen to be in the hospital, even when hidden away locked in a cupboard. Healthcare professionals can also be equipped with tags to enable their colleagues to locate them when required. My daughter was in a sideward while in the acute hospital and nurses were often deemed ‘missing in action’ when they were in one of the side wards.
Technology can resolve so many of these problems but alas, not all of them. With some departments working in different time frames and a lack of coordination around meal and break times the result is lost time that technology cannot recover. However, RTLS technology combined with a Cloud based resource scheduling application will make best use of the available time with the potential to increase productivity across the entire hospital.
Healthcare monitoring and management
When you are in hospital the nurses do a fantastic job of continually monitoring your health, checking for any changes in the baseline for temperature, blood pressure, blood oxygen and any other specific aspects such as blood glucose, International Normalised Ratio (INR – relating to the ability of blood to clot for Warfarin management) dependent on your condition. However, in my experience, once the nurses had located working machines (this was my experience when both my Mum and my daughter were in hospital) they still had to write the results on the patient records at the foot of the bed. On a number of occasions, the records had been removed and they also had to waste their valuable time searching for the records. I also witnessed on a number of occasions, nurses and healthcare assistants having to write notes on scrap pieces of paper (or their hands) with the intention of updating the records when they appeared. I also witnessed some occasions when these notes didn’t actually make it to the records.
There is a clear need for technology to improve this process. It is important to note that there are economies of scale here as many of these problems can use the same technology to provide the information required. In the case of healthcare monitoring, we just need to tie the results to the patient through the use of IoT tags on the patient and the measuring equipment and the results will be immediately available in the Cloud for any healthcare professional responsible for managing the patient’s health.
While on this subject and going back to resource scheduling. On a number of occasions physiotherapists and occupational therapists walked from one side of the hospital to the other to see my daughter only to find the doctors had put a halt on her therapies due to her health. Analytics in the Cloud could be used to automatically alert other healthcare professionals that the patient is not in a position to receive their therapies thus freeing them up for other patients.
Dehydration can be a very difficult condition to identify but it can lead to so many other health problems, some of them very serious. Drinking too much water can also be very dangerous. My daughter suffered her brain injury through drinking too much water. She now has to have her water intake monitored to ensure she drinks enough water but not too much. While she was in hospital she often had nurses telling her she needed to drink more when she had already had her quota. Also, it was very difficult monitoring her water intake when nursing and ancillary staff automatically refreshed her water jug throughout the day, regardless of whether it was empty or not. My daughter was in no position to monitor her fluid intake so unless she had someone with her 24/7 it was rather hit and miss as to whether her water intake was monitored or not. The only way we could overcome this problem was to stop the water jugs and supply four, dated and numbered 500ml water bottles a day for the last six months of her stay in hospital.
The IoT can be used to assist with this process but I do appreciate that patients that are sufficiently mobile to get to the tap will be required to take an active role in their own fluid intake monitoring and management.
Some conditions require constant heart monitoring. Typically, an ECG requires a trip to hospital but it is possible to have sticky plaster based ECG probes attached with the results uploaded to the Cloud. For some conditions, this could very simply prevent serious conditions such as heart attacks and strokes.
Anxiety can be an indication of so many underlying conditions. Some people can suffer with anxiety and not actually know why they are suffering. However, the results are very real and often debilitating. If stress and anxiety can be monitored (using heart and skin sensors for example) it has far greater chance of being managed. Anxiety levels are likely to be significantly higher in hospital than at home and for some people with specials needs anxiety can be mistaken for unmitigated aggression. Understanding when someone is suffering with an anxiety attack will enable an appropriate intervention to reduce anxiety rather than exacerbate it.
Taking anxiety monitoring a stage further, we may be able to reduce the effects of anxiety through changes in the surroundings. Environment can play a big part in managing anxiety. I recently visited a private hospital where the patient had access to a range of lighting controls to change the mood of their private room. During my time in the acute hospital I failed to see how anyone could get any rest despite doctors stating that rest and food were key components to recovery (the food was nearly edible too). It is obviously difficult to rest when you are unable to relax.
Just from my own limited experience I am sure there will be major benefits to patients and staff if IoT assistive technologies are adopted in our hospitals. The IoT has huge potential to reduce the amount of time patients need to be in hospital and may even save lives. It also has the potential to reduce pressure on staff thus improving their effectiveness and maybe even reducing time off due to stress. Nursing staff will spend significantly less time on paperwork and more time with the patients requiring their attention as they will be alerted to the fact automatically when there is a shift from the patient baseline.
It is going to require a joined up approach with all of the stakeholder departments combining their resource and budgets to capitalise on economies of scale for any chance of a significant taken up of IoT technologies. While there are stakeholders with pockets of departmental budget attempting to deploy small scale tactical solutions the results are sadly inevitable. Low impact, high cost and zero potential for any significant return on investment.
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